OBJECTIVE: To investigate the clinical characteristics and risk factor analysis of necrotizing pneumonia in children. METHODS: A retrospective study was used to analyze the case data of 218 children with severe pneumonia hospitalized in the Department of Respiratory Medicine, Children's Hospital of Capital Institute of Pediatrics from January 2016 to January 2020, and they were divided into 96 cases in the necrotizing pneumonia group (NP group) and 122 cases in the non-necrotizing pneumonia group (NNP group) according to whether necrosis of the lung occurred. The differences in clinical characteristics (malnutrition, fever duration, hospitalization time, imaging performance, treatment and regression follow-up), laboratory tests [leukocytes, neutrophil ratio, platelet (PLT), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, and lactate dehydrogenase (LDH)] and bronchoscopic performance between the two groups were compared, and Logistic regression analysis of clinical risk factors associated with necrotizing pneumonia was performed to further determine the maximum diagnostic value of each index by subject operating characteristic curve (ROC). The critical value of each index was further determined by the ROC. RESULTS: The differences in age, gender, pathogenic classification, and bronchoscopic presentation between the two groups of children were not statistically significant (P>0.05); whereas the imaging uptake time of the children in the NP group was higher than that in the NNP group (P < 0.05). The differences in malnutrition, fever duration, length of stay, white blood cell count, neutrophil ratio, CRP, PCT, and D-dimer were statistically significant between the two groups (P < 0.05). The imaging uptake time was lower in children under 6 years of age than in those over 6 years of age, and the imaging uptake time for bronchoalveolar lavage within 10 d of disease duration was lower than that for those over 10 d; the imaging uptake time was significantly longer in the mixed infection group than that in the single pathogen infection group. Logistic regression analysis of the two groups revealed that the duration of fever, hospital stay, CRP, PCT, and D-dimer were risk factors for secondary pulmonary necrosis (P < 0.001, P < 0.001, P < 0.001, P=0.013, P=0.001, respectively). The ROC curves for fever duration, CRP, PCT, and D-dimer were plotted and found to have diagnostic value for predicting the occurrence of pulmonary necrosis when fever duration >11.5 d, CRP >48.35 mg/L, and D-dimer > 4.25 mg/L [area under ROC curve (AUC)=0.909, 0.836, and 0.747, all P < 0.001]. CONCLUSION Children with necrotizing pneumonia have a longer heat course and hospital stay, and the imaging uptake time of mixed pathogenic infections is significantly longer than that of single pathogenic infections. Children with necrotizing pneumonia under 6 years of age have more advantageous efficacy of electronic bronchoscopic alveolar lavage within 10 d of disease duration compared with children in the group over 6 years of age and children in the group with disease duration >10 d. Inflammatory indexes CRP, PCT, and D-dimer are significantly higher. The heat course, CRP, PCT, and D-dimer are risk factors for secondary lung necrosis in severe pneumonia. Heat course >11.5 d, CRP >48.35 mg/L, and D-dimer >4.25 mg/L have high predictive value for the diagnosis of necrotizing pneumonia.
C-Reactive Protein/analysis* ; Child ; Child, Preschool ; Humans ; Malnutrition ; Necrosis ; Pneumonia/diagnosis* ; Pneumonia, Necrotizing ; Prognosis ; ROC Curve ; Retrospective Studies ; Risk Factors

Kikuchi-Fujimoto disease (KFD) is a self-limiting disease characterized by subacute necrotizing lymphadenitis. This benign disease is frequently associated with prolonged fever and mostly occurs in young Asian women. KFD is generally diagnosed using a biopsy of affected lymph nodes and spontaneously resolves in several months. Although the causative agent is believed to be infectious, the etiology remains unknown. Some cases of KFD are associated with viral infections, including Epstein-Barr virus, human herpes virus 6, and parvovirus B19 infection. Herein, we report a case of KFD associated with Mycoplasma pneumoniae infection.
Asian Continental Ancestry Group ; Biopsy ; Female ; Fever ; Herpesvirus 4, Human ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Lymph Nodes ; Lymphadenitis ; Mycoplasma pneumoniae ; Mycoplasma ; Parvovirus ; Pneumonia, Mycoplasma

Mycoplasma pneumoniae is responsible for approximately 20% to 30% of community-acquired pneumonia, and is well known for its diverse extrapulmonary manifestations. However, acute necrotizing pancreatits is an extremely rare extrapulmonary manifestation of M. pneumoniae infection. A 6-year-old girl was admitted due to abdominal pain, vomiting, fever, and confused mentality. Acute necrotizing pancreatitis was diagnosed according to symptoms, laboratory test results, and abdominal computed tomography scans. M. pneumoniae infection was diagnosed by a 4-fold increase in antibodies to M. pneumoniae between acute and convalescent sera by particle agglutination antibody assay. No other etiologic factors or pathogens were detected. Despite the occurrence of a large infected pseudocyst during the course, the patient was able to discharge without morbidity by early aggressive supportive care. This is the first case in Korea of a child with acute necrotizing pancreatitis associated with M. pneumoniae infection.
Abdominal Pain ; Agglutination ; Antibodies ; Child* ; Female ; Fever ; Humans ; Korea ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pancreatitis ; Pancreatitis, Acute Necrotizing* ; Pneumonia ; Pneumonia, Mycoplasma* ; Vomiting

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is a widely used method for providing nutritional support for patients who require prolonged tubal feeding. As survival times of PEG inserted patients increase, PEG related complications are also increasing. For this reason, we decided to review complications related to PEG. MATERIALS AND METHODS: A retrospective review of medical records was conducted for patients who received PEG placement between January 2004 and March 2013 in our hospital. Of the total 331 cases of PEG placement, 131 cases of PEG exchanges were excluded and a total of 200 cases were included in our review. We reviewed the baseline characteristics of all PEG inserted patients and complications related to PEG insertion. RESULTS: Complications related to PEG developed in 45 of 200 patients (22.5%). Peristomal infection occurred in 22 patients (11.0%) and buried bumper syndrome occurred in 10 patients (5.0%). Other complications that occurred in 13 patients were hemorrhage (3.0%), leakage (1.0%), aspiration pneumonia (1.0%), ileus (0.5%), necrotizing fasciitis (0.5%) and gastro-colo-cutaneous fistula (0.5%). The characteristics according to age, gender, procedure place and underlying disease were not different between the complication group and non complication group. The onset time to complication was significantly different between the buried bumper syndrome group and the other complication groups (P=0.035). CONCLUSIONS: Peristomal infection was the most common complication of PEG in our hospital. Late peristomal infection and buried bumper syndrome occurred more often than previous studies. Buried bumper syndrome was more likely to occur in later time compared with the other complications.
Fasciitis, Necrotizing ; Fistula ; Gastrostomy* ; Hemorrhage ; Humans ; Ileus ; Medical Records ; Nutritional Support ; Pneumonia, Aspiration ; Retrospective Studies

PURPOSE: Necrotizing fasciitis is a rare, life-threatening, and rapidly progressive soft tissue infection associated with extensive necrosis. Despite recent advances in its management, outcomes have not improved and the mortality rate from this disease is still high. The objective of this study was to identify the predictive factors of mortality for patients diagnosed with necrotizing fasciitis in the ED. METHODS: A total of 38 necrotizing fasciitis cases diagnosed by an emergency department from January 2001 to April 2012 were retrospectively reviewed. RESULTS: Mean serum lactate levels were significantly higher in non-survivors than survivors (8.03+/-4.48 vs. 3.26+/-2.46, p=0.001). Serum glucose levels, arterial pCO2, and HCO3 values were significantly lower in non-survivors than survivors (114.75+/-78.01 vs. 203.92+/-122, p=0.027;25.02+/-6.82 vs. 32.74+/-7.06, p=0.005; 13.76+/-6.08 vs. 20.63+/-5.12, p=0.002, respectively). Microorganisms isolated included coagulase-negative Staphylococci from seven patients (18.4%), Acinetobacter baumannii from six patients (15.8%), Enterococcus faecium from five patients (13.2%), Staphylococcus aureus from five patients (13.2%), Beta-hemolytic Streptococcus from three patients (7.9%), Enterococcus faecalis from three patients (7.9%), Escherichia coli from two patients (5.3%), Pseudomonas aeruginosa from two patients (5.3%), Enterobacter cloaca from two patients (5.3%), Klebsiella oxytoca from two patients (5.3%), and Klebsiella pneumonia from two patients (5.3%). More Acinetobacter baumannii were cultured from the non-survival group than the survival group (p=0.022), while there was no statistical difference from surgical treatment between the survivor and non-survivor group (p=0.460). Interestingly, serum lactate levels above 4.0 mmol/L were a predictor of mortality in the ED (OR, 20.000; confidence interval, 1.796-222.777). CONCLUSION: Initial serum lactate levels above 4 mmol/Larea predictor of mortality in patients diagnosed with necrotizing fasciitis in the ED.
Acinetobacter baumannii ; Blood Glucose ; Cloaca ; Emergencies* ; Enterobacter ; Enterococcus faecalis ; Enterococcus faecium ; Escherichia coli ; Fasciitis, Necrotizing* ; Humans ; Klebsiella ; Klebsiella oxytoca ; Lactic Acid ; Mortality* ; Necrosis ; Pneumonia ; Pseudomonas aeruginosa ; Retrospective Studies ; Soft Tissue Infections ; Staphylococcus aureus ; Streptococcus ; Survivors

PURPOSE: Necrotizing fasciitis is a rare, life-threatening, and rapidly progressive soft tissue infection associated with extensive necrosis. Despite recent advances in its management, outcomes have not improved and the mortality rate from this disease is still high. The objective of this study was to identify the predictive factors of mortality for patients diagnosed with necrotizing fasciitis in the ED. METHODS: A total of 38 necrotizing fasciitis cases diagnosed by an emergency department from January 2001 to April 2012 were retrospectively reviewed. RESULTS: Mean serum lactate levels were significantly higher in non-survivors than survivors (8.03+/-4.48 vs. 3.26+/-2.46, p=0.001). Serum glucose levels, arterial pCO2, and HCO3 values were significantly lower in non-survivors than survivors (114.75+/-78.01 vs. 203.92+/-122, p=0.027;25.02+/-6.82 vs. 32.74+/-7.06, p=0.005; 13.76+/-6.08 vs. 20.63+/-5.12, p=0.002, respectively). Microorganisms isolated included coagulase-negative Staphylococci from seven patients (18.4%), Acinetobacter baumannii from six patients (15.8%), Enterococcus faecium from five patients (13.2%), Staphylococcus aureus from five patients (13.2%), Beta-hemolytic Streptococcus from three patients (7.9%), Enterococcus faecalis from three patients (7.9%), Escherichia coli from two patients (5.3%), Pseudomonas aeruginosa from two patients (5.3%), Enterobacter cloaca from two patients (5.3%), Klebsiella oxytoca from two patients (5.3%), and Klebsiella pneumonia from two patients (5.3%). More Acinetobacter baumannii were cultured from the non-survival group than the survival group (p=0.022), while there was no statistical difference from surgical treatment between the survivor and non-survivor group (p=0.460). Interestingly, serum lactate levels above 4.0 mmol/L were a predictor of mortality in the ED (OR, 20.000; confidence interval, 1.796-222.777). CONCLUSION: Initial serum lactate levels above 4 mmol/Larea predictor of mortality in patients diagnosed with necrotizing fasciitis in the ED.
Acinetobacter baumannii ; Blood Glucose ; Cloaca ; Emergencies* ; Enterobacter ; Enterococcus faecalis ; Enterococcus faecium ; Escherichia coli ; Fasciitis, Necrotizing* ; Humans ; Klebsiella ; Klebsiella oxytoca ; Lactic Acid ; Mortality* ; Necrosis ; Pneumonia ; Pseudomonas aeruginosa ; Retrospective Studies ; Soft Tissue Infections ; Staphylococcus aureus ; Streptococcus ; Survivors

Klebsiella pneumoniae has been reported to be the most common pathogen causing pyogenic liver abscess. K. pneumoniae liver abscess occurs fairly often in patients with diabetes mellitus, and is commonly associated with metastatic infections such as brain abscess, endophthalmitis, lung abscess, osteomyelitis, prostatitis, necrotizing fasciitis and infection in other sites. Although septic pulmonary embolism (SPE) is uncommon, it is a serious metastatic complication of K. pneumoniae liver abscess. Chest computed tomography (CT) scans are crucial in making the early diagnosis of SPE; however, it does not provide the basis for a definitive diagnosis. A 70-year-old man was referred to the Department of Pulmonology due to cough and an abnormal chest radiography. The chest CT scans revealed relatively well-demarcated, round multiple nodules with peripheral preponderance, cavitary mass in the right upper lobe of the lung and low-density hepatic cystic masses. Bronchoscopic examination and percutaneous needle aspiration of the lung were performed, but there was no evidence of malignancy. Finally, K. pneumoniae was grown from a bronchial washing specimen and blood culture. Intravenous carbapenem was administered over a 3-week period and follow-up CT scans showed improvement in both the lung and the liver. We report a case of K. pneumoniae liver abscess complicated with SPE requiring differential diagnosis of hematogenous metastatic malignancy on CT scans in an elderly patient.
Aged ; Brain Abscess ; Cough ; Diabetes Mellitus ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Endophthalmitis ; Fasciitis, Necrotizing ; Follow-Up Studies ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver* ; Lung ; Lung Abscess ; Needles ; Osteomyelitis ; Pneumonia ; Prostatitis ; Pulmonary Embolism* ; Pulmonary Medicine ; Radiography ; Thorax ; Tomography, X-Ray Computed

PURPOSE: We investigated the incidence and clinical course of hypoalbuminemia and identified relevance of prognosis including mortality in extremely low birth weight infants (ELBWIs). Also, we assessed the efficacy of intravenous albumin infusion. METHODS: A retrospective study including 83 preterm infants <1,000 g of birth weight who were admitted to Ajou university hospital's neonatal intensive care unit from January 2008 to December 2012 was performed. Patients were divided into the normoalbuminemia (> or =2.5 g/dL serum albumin, n=42) group and the hypoalbuminemia (<2.5 g/dL serum albumin, n=41) group, and also the hypoalbuminemia group were subdivided into the intravenous albumin infusion group (n=36) and the control group (n=5). RESULTS: Of those 83 ELBWIs, 41 infants (49.4%) were classified as the hypoalbuminemia group. Associated conditions with hypoalbuminemia were patent ductus arteriosus (PDA, 19.5%), intraventricular hemorrhage (IVH, > or =grade III, 4.9%), necrotizing enterocolitis (NEC, > or =stage IIa, 46.3%), pneumonia (4.9%), sepsis (24.4%). In univariate analysis, there were no statistically significant differences in major morbidities such as PDA, IVH, NEC, bronchopulmonary dysplasia and mortality between the normoalbuminemia and the hypoalbuminemia groups except gestational age (26+6+/-2+1 vs. 26+0+/-1+5, P=0.045) and birth weight (868+/-117 vs. 783+/-121, P=0.002). In multivariate logistic regression, birth weight is the only meaningful factor associated with hypoalbuminemia (OR.995, 95% CI .990-.999, P=0.019). The mortality (47.2% vs. 0%, P=0.065) and morbidities did not differ between the intravenous albumin infusion and the control group. CONCLUSION: In ELBWIs, there were no significant differences in major morbidities and mortality between the hypoalbuminemia and the normoalbuminemia groups. The lower birth weight is the only factor associated with hypoalbuminemia. In addition, major morbidities and mortality rate were not affected by the albumin infusion.
Birth Weight ; Bronchopulmonary Dysplasia ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Gestational Age ; Hemorrhage ; Humans ; Hypoalbuminemia* ; Incidence ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Logistic Models ; Mortality ; Pneumonia ; Prognosis ; Retrospective Studies ; Sepsis ; Serum Albumin

A 62-year-old diabetic female was admitted to the hospital with fever and pain in both legs. Computed tomography scans of the abdomen revealed necrotizing fasciitis of the right thigh extending into the abdominal wall, and abscesses on the right psoas muscle. Magnetic resonance imaging showed increased T2 signal intensity along the peroneus muscle and fascia of the lower left leg. The patient received antibiotics and underwent debridement of the infected and necrotic tissue. Intra-abdominal abscesses were drained. Blood and pus cultures showed growth of Klebsiella pneumoniae, as had been suspected due to string test results showing hypermucoviscosity. Free-skin grafts were performed to repair tissue loss and the patient was subsequently discharged 82 days after admission. This represents the first reported case of necrotizing fasciitis and psoas muscle abscess caused by a hypervirulent strain of K. pneumoniae in Korea.
Abdomen ; Abdominal Abscess ; Abdominal Wall ; Abscess ; Anti-Bacterial Agents ; Blood ; Debridement ; Fascia ; Fasciitis, Necrotizing* ; Female ; Fever ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Korea ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Muscles ; Pneumonia ; Psoas Abscess* ; Psoas Muscles ; Suppuration ; Thigh ; Transplants

A 62-year-old diabetic female was admitted to the hospital with fever and pain in both legs. Computed tomography scans of the abdomen revealed necrotizing fasciitis of the right thigh extending into the abdominal wall, and abscesses on the right psoas muscle. Magnetic resonance imaging showed increased T2 signal intensity along the peroneus muscle and fascia of the lower left leg. The patient received antibiotics and underwent debridement of the infected and necrotic tissue. Intra-abdominal abscesses were drained. Blood and pus cultures showed growth of Klebsiella pneumoniae, as had been suspected due to string test results showing hypermucoviscosity. Free-skin grafts were performed to repair tissue loss and the patient was subsequently discharged 82 days after admission. This represents the first reported case of necrotizing fasciitis and psoas muscle abscess caused by a hypervirulent strain of K. pneumoniae in Korea.
Abdomen ; Abdominal Abscess ; Abdominal Wall ; Abscess ; Anti-Bacterial Agents ; Blood ; Debridement ; Fascia ; Fasciitis, Necrotizing* ; Female ; Fever ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Korea ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Muscles ; Pneumonia ; Psoas Abscess* ; Psoas Muscles ; Suppuration ; Thigh ; Transplants